Very recently, unusual thrombotic events in combination with severe thrombocytopenia have been reported 1–2 weeks following SARS-CoV-2 vaccination with ChAdOx1 nCov-19 (AstraZeneca). This condition, termed VITT (vaccine-induced immune thrombotic thrombocytopenia), has been related to high risk of fatal outcome with both ischaemic and haemorrhagic complications.1 2 Optimal treatment strategies still need to be elucidated—especially in case of cerebral sinus venous thrombosis (CSVT) with associated brain haemorrhage as the underlying thrombotic event. We here report our clinical experience with two young women diagnosed with VITT-associated CSVT, treated with high-dose intravenous immunoglobulins (IVIGs), corticosteroids and argatroban in the hyperacute phase, followed by dabigatran resulting in excellent outcome. A 39-year-old woman with an unremarkable medical history was admitted with severe holocephalic headache since 2 days. Eight days earlier, she had received the first vaccination with ChAdOx1 nCov-19 (AstraZeneca). Physical and neurological examination was normal. Laboratory investigations revealed moderate thrombocytopenia (84×109/L) and significantly elevated D-dimer (14.2 mg/L; normal <0.5 mg/L). Fibrinogen and other routine parameters were normal (table 1). Brain CT including venography was unremarkable as were CT pulmonary angiography and compression ultrasound of both legs. Coincidentally, the patient had contact with a COVID-19-positive person a few days after vaccination and SARS-CoV-2 reverse transcription PCR (RT-PCR) on admission was positive with cycle threshold value 26 on a nasopharyngeal swab. Prophylactic treatment with danaparoid 750 IU two times per day subcutaneously and intravenous dexamethasone 40 mg were started. While the …

中文翻译：

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ChAdOx1 nCov-19疫苗接种后疫苗诱导的免疫血栓性血小板减少症相关脑窦静脉血栓形成的成功管理

最近，在用 ChAdOx1 nCov-19 (AstraZeneca) 接种 SARS-CoV-2 疫苗后 1-2 周报告了不寻常的血栓形成事件和严重的血小板减少症。这种情况被称为 VITT（疫苗诱导的免疫血栓性血小板减少症），与缺血性和出血性并发症导致致命后果的高风险有关。 1 2 仍需阐明最佳治疗策略，尤其是在脑窦静脉血栓形成的情况下（ CSVT) 与相关的脑出血作为潜在的血栓形成事件。我们在此报告我们对两名诊断为 VITT 相关性 CSVT 的年轻女性的临床经验，她们在超急性期接受大剂量静脉注射免疫球蛋白 (IVIG)、皮质类固醇和阿加曲班治疗，随后接受达比加群治疗，结果极佳。一名 39 岁女性，病史无异常，因 2 天后出现严重的全头性头痛入院。八天前，她接受了第一次 ChAdOx1 nCov-19 (AstraZeneca) 疫苗接种。体格和神经系统检查正常。实验室检查显示中度血小板减少症 (84×109/L) 和 D-二聚体显着升高 (14.2 mg/L; 正常 <0.5 mg/L)。纤维蛋白原和其他常规参数正常（表 1）。包括静脉造影在内的脑 CT 和双腿的 CT 肺血管造影和压缩超声均无异常。巧合的是，该患者在接种疫苗后几天与一名 COVID-19 阳性者接触，入院时 SARS-CoV-2 逆转录 PCR (RT-PCR) 呈阳性，鼻咽拭子的周期阈值为 26。开始每天两次皮下注射达那帕罗 750 IU 和静脉注射地塞米松 40 mg 进行预防性治疗。虽然…